Alzheimer disease — structured clinical viva

Formulate probable AD dementia (McKhann): insidious progressive amnestic syndrome with IADL interference and no better alternative on available history/imaging pattern. Clinical diagnosis does not require a blood test; emerging blood and CSF/PET biomarkers can increase biological certainty in specialist pathways (ATN: A+T+ as research biological AD) but need counselling, access awareness, and must not replace exclusion of delirium/reversibles. 2024 criteria updates exist — mention awareness without inventing local funding rules.^[1][2][3]

Do not automatically stop donepezil because the disease progresses: DOMINO-AD supports cognitive/functional benefit of continuation versus withdrawal in moderate-to-severe AD if tolerated; consider memantine for moderate–severe stages with standard titration and renal caution.^[4]

New suspiciousness is BPSD — apply DICE, exclude delirium/medical drivers, non-drug first. Antipsychotics only if severe risk remains: counsel increased mortality risk, time-limit, review.^[5][6]

Financial capacity: decision-specific Appelbaum assessment (understand, appreciate, reason, communicate), not automatic incapacity from diagnosis; arrange supports and legal pathways as needed.^[7]